The pathogenesis pamusoro tibhii. The etiology pamusoro tibhii. Zviratidzo uye nezviratidzo chorurindi

About tibhii atinzwe zhinji, asi vanhu vashoma vanoziva ngozi iyi chirwere inotyisa. Kwemakore akawanda, vanachiremba munyika yose akadzidza zvinhu zvikaita kuti pave chirwere, chikuru zviratidzo uye zviratidzo. Panguva ino, zvakanga vakawana kuti okutanga padariro tibhii kuti mapapu nedzimwe nhengo zvinogona kuitika nenzira asymptomatic chimiro, uye kushaya kurapwa kunotungamirira zvakakomba matambudziko.

Brief ruzivo pamusoro chirwere

Kusvika panguva pathogenesis kuti tibhii akadzidza zvakakwana. Ichi chirwere ngozi uye zvikuru chinotapukira zvinokonzerwa noutachiona vamiririri kubva genus Mycobacterium.

Kune mhando dzakawanda zvigare kuti vanotsamwisa zvirwere muvanhu. Idzi dzinosanganisira:

• munhu, kunoitika kakawanda, nekurangarira kuti 92% vose rakashuma zviitiko;
• bovine, kunoguma yekudyidzana zvishoma chirwere, vanotambura kubva munenge 5%;
• zvenguva, kunyanya akaparadzirwa South Africa, muRussia hosha dzakaonekwa muna 3% dzevarwere;
• negonzo uye shiri, rinowanikwa chete vane immunodeficiency inoti munhau.

vanhu vashoma vanoziva kuti anatomi ari kufema gadziriro hakungogumiri tibhii. The bacillus riri achirova:

• mapfupa;
• nemudumbu;
• genitourinary hurongwa;
• uropi.

Pasinei nzvimbo, chirwere ngozi kwazvo uye vaizongoguma kutungamirira kurufu kana untreated.

The chirwere ane refu incubation nguva. Zviratidzo zvokutanga kuonekwe pashure 3 months - 1 gore pashure pakatanga ari rwarisa pomutumwa.

nhamba

Health nyanzvi pasi pose vari zvakakomba hanya nokukurumidza kupararira chirwere. Russia muna pamazita munyika anotora 22th nzvimbo.

Kare, unorema utachiona vanhu vakanga vachishumira mitongo mutorongo. Asi sezvo mangwanani 90-ies vakatanga yatanga, uye bacillus kuti hombe kupararira.

Daily chirwere chitsva zviitiko tibhii pakati mhuri vakapfuma, vana vakawanda vaibva varwere.

Muna zvoutano sangano, chokwadi ichi akanga kusonganirana vasanyanye mararamire vemo, uyo akanga achangobva kuona panguva uye kunokonzerwa enyika kugadzirisa nyika.

Kwemakore akawanda ichi denda nyanzvi kunge zvakatanga chirongwa seti zviyero chokudzivirira kuti kubvumira shoma kudzikamisa zvinhu, kuderedza hwevanhu vanorwara uye vanofa. Idzi dzinosanganisira:

• Vaccination pamusoro vachangoberekwa muchipatara;
• club nyaya itsva kushandisa Mantoux bvunzo (vana), uye x-mwaranzi (nedzevakuru).

Tiibhii bacillus zvikuru husingakwanisi kwezvakatipoteredza kuchinja, saka nguva anodzokororwa chine musoro mamiriro mumvura, nyika uye zvichingodaro. N. For asiri zvaidiwa dzinokosha mitemo utsanana mukana wokusvika yakakwirira zvikuru.

mamirire zviratidzo

The chikuru Panobva pathogenesis ndiko kupinda pakati pathogenic tsotso kupinda mumuviri. vanhu vakadaro havasi pakarepo kuwira kurwara, maererano, hapana kugunun'una.

Nengano kwakaderera ari kutapata angamuka:

• zvishomanana kuwedzera tembiricha muviri;
• yakawedzera kwemwoyo;
• zvakakomba vangadikitira usiku;
• ndinotsveruka pamwe tyisa ganda pallor;
• simba, dzungu;
• kukosora;
• sputum zvakasanganiswa neropa.

Kuipa vakawanda mamiriro zvauya nokuda zvinokachidza nomuchetura utachiona. The zvakawanda nhamba zvikuru zvikuru raidudzwa zviratidzo.

Zviratidzo zvokutanga tibhii pavarwere ane simba rokuzvidzivirira kungava yakaderera kana ndisipo zvachose.

Wakakura zvikuru mararamiro uye nokukurumidza kunoita iri kuchengetwa gomunhu zvoutano.

Kana microorganism rinowisirwa:

• Bone - pane kurwadziwa kwakasimba majoini ose uye kuomarara.
• Brain - pane kuda kurutsa, kurutsa, anotemwa nemusoro, uye tsandanyama kurwadziwa.
• Urinary hurongwa - murwere anogara anonzwa dzakayerera dundira. The azara nechitarisiko ropa iri weti.
• Nemudumbu (Git) - pane chenguva abdominal kusanzwa, kuda kurutsa, tsvuku mitaro mu pachituru.
• Skin - wayo pechiso vakaumba nodules vakazadzwa pus, izvo zvinoratidzwa nenguva.

Muchirwisa colour ane refu nzira tibhii pane anogumbura granulomatous mhando muitiro kuti anogona kuonekwa chero zvakakanganisa nenyere. Kuziva zvayo kushandiswa ano nzira nechirwere.

mapoka njodzi

Medicine kare dzakaratidza kuti pathogenesis pakati tibhii kunoenderana mamiriro muviri paaizvidzivirira hurongwa.

Kubva yekutapurira hapana angati, asi chepamusoro boka pangozi zvinosanganisira vanhu:

• HIV uye AIDS;
• vasungwa;
• chirwere siyana chisingaperi zvirwere (maronda ari zvomudumbu ezvinhu, chirwere cheshuga, etc ...);
• vane tsika dzakaipa;
• muduku;
• kurega utsanana mitemo;
• Kugara neZvapupu munhu ane HIV;
• panguva pamuviri;
• kuona kugara mupfungwa;
• asingagamuchiri mavhitaminzi nemaminarari anodikanwa;
• kurarama zvakatipoteredza vaitambura munzvimbo;
• kubva mari shoma mhuri;
• hapana wakaiswa nzvimbo dzokugara.

Kana kusashanda, ari pathological muitiro, ari pathogenesis pamusoro tibhii kunoratidzwa ichiwedzerwa rwarisa.

shepi

The mhando chirwere kunoenderana ya kurapwa, asi anozivisa mukana yekutapurira vamwe vanhu. Govera zvinotevera chehupenyu tibhii:

1. Open. Kuchengetwa maronda ose mumapapu. Kana abudisa sputum kuongorora dzakatsigira kuvapo utachiona mairi, munhu ndiye rwarisa.
2. Kuvharwa. With zvakaipa mugumisiro, murwere haasi mutakuri chirwere.

Kana tsvimbo wokutanga apinda muviri anoratidza chikuru chimiro, mune vakomana zvakaitika yechipiri.

Mukuwedzera, chirwere unogona siyana zvakasikwa kuparadza:

• miliary;
• neakangwara;
• infiltrative;
• shoma;
• cheesy;
• fibrocavernous;
• tuberkulemny;
• cavernous;
• cirrhotic;
• tuberculous pleurisy.

Course chirwere pauduku uye panguva pamuviri

The etiology pamusoro tibhii anoratidza kuti chinonyanya wokuwana chirwere vanhu vane simba zvirwere. kutyora ringava vachiberekwa, asi kazhinji rinowanikwa muitiro upenyu, achifuridzirwa siyana zvinokonzera.

In pauduku kuchengetedzwa gadziriro haisi zvakazara kuumbwa, saka mukana wokutapukirwa yakawanda Ivan Kuchin maererano nezera romwana. E. Than ndiye pasi, kwakondiko kwakaipa zvimiti.

Mushure chirwere, chirwere rinowanikwa nenzira sezvinoitwa vakuru, asi zvikuru chimiro. Dzinenge kusiyana hazvina basa.

TB panguva pamuviri hachisi chikonzero wake kugumiswa.

Yezwi yezviri kutotanga anogona kuonekwa yokutanga trimester kana pashure pakukurukura. Pane dzimwe nguva vashoma. Izvi imhaka basa zvirwere, uye kuchinja kwemakemikari omuviri mumuviri.

HweHIV kubva mudumbu haasi nguva dzose kuchengetwa. Kumboda zviri kwese kuti zvinotevera siyana:

• fibrocavernous;
• zvakakomba zvinoparadza;
• neakangwara.

utachiona kwakadaro kuyambuka nyore placental chinodzivirira, kukonzera yakanyanya kuvhiringidzika mudumbu.

Kamwe kuongororwa zvakarurama murwere ari pasi kudzorwa gayinakorojisiti uye Tibhii.

Treatment atanga pakarepo, pamwe zvinhu dzakasiyana kuti vane mudukusa inokanganisa mwana asati aberekwa.

Kana maperembudzi dzakaonekwa nokufamba kwenguva, fungidziro nokuti mukadzi uye mbudzana-ushamwari, asi pane kusaina. Dzimwe nguva pamuviri richiri inokurudzirwa.

tsvakurudzo

Pashure pakuonekwa zviratidzo varwere kufungira rokutanga Kashoma kushanyira chiremba, asi pasina. Zvinokonzera masiki isingakuvadzi kuneta vangavanda kwete chete tiibhii asiwo vamwe zvirwere zvinotyisa.

Kunyange zvishomanana Kuipa utano asina zviratidzo chakasimba nezvirwere kufema, asi nefivha kunofanira kuva nguva kushanyira chiremba.

Initial rokuongorora kuchaita chiremba anoteerera kunyunyuta zvose, achatora kufungawo etiology pamusoro tibhii uye kupa nhungamiro vanhuwo miedzo (ropa uye weti), uye zvimwe zvidzidzo zvakakodzera zvinogona:

• Fluorography. 1 wakaitwa gore negore kubva makore 15. Kunoitawo kuti kuziva pulmonary tiibhii nezvimwe zvirwere kufema. Vanobatanidzwa ndandanda fanira kuongorora kuti basa, N. asati kuenda kuhondo, uye zvichingodaro. Kana mugumisiro x-mwaranzi ndiyo debatable, mamwe maekisirei kuita.
• Mantoux bvunzo. Vanhu vazhinji vanokanganisa kunyonganisa naro batanidza. Izvi nechirwere ane tibhii chinokosha. Voitakura kunze vose vana makore kubva 1 gore 14 - 15 makore, dzimwe nguva kusvika 17. A duku tsono iri akaiswa pasi ganda ane pfuma - tuberculin. In ayo mamiriro rine tsvina yose pathogenic zvimiti. "A bhatani" kuoneka pashure kwakadaro kuonana. Nokuti Kukoshesa mugumisiro akayera dhayamita kwayo.
• Linked immunosorbent munhu akaidza (Elisa). Kunoitawo kuti kuona pamberi tusingaoneki muropa panguva pakudzidza.
• Sputum kuongorora Ziehl-Neelsen. Kuitwa varwere vose pamwe kwenguva refu chikosoro. Sputum rinamakwapa chaiyo mhinduro, izvo anobvumira kuona pamberi pathogenic bacilli.
• Bacteriological sowings. Rwunoita munoziva kuti tsvimbo mhando kushatirisa chirwere. Kudyara dzinokura inenge 1-2 mwedzi, asi kunoita migumisiro yakarurama kwazvo, kunoita kuti kusarudza zvinobudirira kurapa.

Nokuti vanofungidzirwa tiibhii dzimwe nhengo Kuwedzera kuitwa:

• Maekisirei;
• MRI kana CT scan iri sei nzvimbo;
• encephalogram uye m. p.

The pathogenesis pamusoro tibhii ane zvakafanana chaizvo zvinoitwa nevamwe zvirwere zvakawanda, zvakadai kenza, saka kwete nguva dzose zvinogoneka kufungidzira iye pakarepo.

mabatiro

Selection yokurapa kunyanya kunobva pathogenesis uye TB yekuongororwa. It rinoitwa pasi pesimba TB nyanzvi uye anotora nguva refu. Kazhinji, ndizvo 2 namakore, zvishoma zvishoma 3-4.

Pakusarudza zvinodhaka zano inotsamira zvinhu zvakawanda. Kazhinji, chiremba anotora yakadaro chisarudzo pahwaro:

• ezvinhu omurwere;
• zera uye pabonde;
• ongororo zvabuda, uye zvichingodaro. n.

Zvinangwa chikuru kurapwa:

• kuti murwere non-chinotapukira;
• inotokonya nokuporesa wakaremara munyama;
• kudzorera utano.

Positive zvingatarisirwa kubudirira uchibatsirwa zvinotevera zvinodhaka:

• Para-aminosalicylic acid.
• "Streptomycin yakawanikwa".
• "Kanamycin".
• "Rifampicin".
• "Ftivazid".
• "Pyrazinamide".
• "Ethionamide".

Kunyanya kushandiswa 3, 4, kana 5 yenhengo panguva imwe chete.

Iva nechokwadi kuti kushandisa mishonga, kwenguva refu uye chipimo chemushonga akatsunga nomumwe.

Pashure kushandisa chisimba mishonga rinenge patsva kwacho anononoka uye kwete chaizvo sezvo zvichidiwa, saka, nokuti dzinongoitika zvinyama kugadzira muitiro kazhinji ushandiswe phthisiatricians pathogenetic kurapwa. Izvi zvinosanganisira wose-siyana mabasa kuti vaite basa rakanaka. Izvi zvinosanganisira mabiko:

• Anti-anogumbura vamiririri;
• immunomodulators;
• makemikari;
• B mavhitaminzi;
• sorbents;
• zvinodhaka kudzivirirwa uye kudzorerwa chiropa (hepatic);
• glutamic asidhi;
• anticoagulants;
• antikininov;
• anabolic steroids;
• antiallergic yomuchipatara nevamwe.

mashandiro

Kakawanda, kutanga chimiro chirwere haadi kuvhiya kurapwa. In mazhinji kacho pasina nzira dzakadaro kuita. Kana zvinokanganisawo mumapapu rinoitwa:

• Lobectomy.
• Resection.
• Bilobektomiyu.
• Pneumonectomy.
• Kavernoektomiyu.
• Pneumothorax.

Tichitarisa pathogenesis pamusoro extrapulmonary tiibhii pacho anogona kuiswa kuvhiyiwa.

Apo matambudziko kubva nemudumbu ane ushandiswe purogiramu kana zvashata kuvhiyiwa utachiona kubvisa migumisiro yacho.

TB CNS kubatwa kunyanya kuchinja nzira. Kana vasinganzwi kubatsira, endai kubviswa maronda. Uyu chaizvo kunzwisisa nzira, izvo zvingaita kuti kusingarapiki nemigumisiro.

Purulent ganda granulomas kunogonawo kuvhiyiwa.

Chinangwa chikuru zviito zvakadaro - kubvisa migumisiro chirwere uye zvichida nokudzosazve kwakakanganisa hurongwa.

Zvokuita kuti kwete kuwana

Pasinei apererwa kutamburira netiibhii yezvokurapa, zvokurwara achiri zvakakurumbira zvikuru vemo, saka hapana chakaipa vachaziva sei kuti uzvidzivirire uye mhuri yako:

• Vaccination. Ita kubaya ichi nevabereki vavo, asi regai kusiya izvozvo. Kunoitawo kuti kukudziridza simba kutapata mwana pazvirwere, iyo inova zvikuru simba pashure kusvika 1 gore. Somugumisiro, mwana haasi kurwara neTB, kana kuutakura iri nyore nenzira.
• Regular kuongorora. Kunoitawo kuti kuziva chirwere chichiri kutanga, uye vaite anobudirira kurapwa kudzivirira utachiona hombe nhamba vanhu. Izvi zvinosanganisira Mantoux bvunzo uye muchipfuva X-ray.

Mamwe mapoka varwere vanoonekwa chokudzivirira mishonga, izvozvo anotarisana:

• Kuva simba rokuzvidzivirira kana chirwere zvemapapu chirwere, nemudumbu, musimboti tsinga.
• Kuramba muimba imwe chete munhu ane HIV.
• Kuva kuchinja ari kufema turakiti tikafunga kutambura tibhii.
• Childhood pamwe murombo nemigumisiro Mantoux bvunzo.

Kuwedzera zvokurapa kupindira, pane zvinoverengeka vanorumbidza anogona kuderedza ngozi kuva chirwere. Kuti aite izvi,

• maekisesaizi nguva dzose;
• kudya kunovaka muviri;
• kunditambudza muropa;
• kugeza maoko kwazvo vasati vachidya uye pashure kuenda dzevoruzhinji;
• nevandagara nemunhu vanorwara;
• zvakanaka disinfected chena nzvimbo iri chirwere;
• nguva dzose kutora mavhitaminzi uye kugadzirira ane polyunsaturated mafuta acids naOmega-3.

All-TB nezvokurara, vanachiremba vanoziva zvishoma chakavanzika sei yekuzvidzivirira makaita tibhii. Kuti aite izvi, unofanira kudya mangwanani uye kudzivisa yakareba nzara masikati (kunyanya kana kudiwa kushandisa mabhazi). Zvinofungidzirwa kuti kubvira bacillus ane anongoda hapana mukana zvinopfuura muviri.

yematambudziko

The akaipa Migumisiro tibhii segwapa zvavo, kunonoka kushanya kune chiremba uye hanya Diagnostics. Kumhanya fomu anogona kukanganisa vanhu:

• cardiac uye kufema kukundikana;
• ropa kubva kwakakanganisa nhengo;
• ulceration, fistula;
• vasingadzoreki renal nerevane chiropa;
• Kugadzirwa granulomas panyika muviri;
• amyloidosis;
• pneumothorax;
• Kuipa motokari basa;
• kuremara;
• sepsis;
• neronda rinonyenga;
• necrosis;
• chaanoziva;
• zvinouraya.

Kana zvinetso zvikaonekwa, kufungidzira kwechirwere ichi hachina kunaka.

Kubva pane zvose zvataurwa pamusoro apa, tinogona kugumisa kuti chirwere chacho chinokonzera zviratidzo zvakasiyana-siyana. Zviratidzo zvekutanga zvepermonary tuberculosis zvinogona kuratidzirwa nekukanganiswa kwenguva refu, kwete kubviswa nemishonga inokanganisa. Izvi zvinofanira kutarisa murwere uye kumuita kuti aone chiremba. Zvakakosha kuyeuka kuti chirwere chacho chinoporesa zvakanaka nekurapa panguva yakakodzera, uye kana zvichizochinja kune imwe nzira isina hanya, njodzi yezvinetso zvisingatauri zvinotungamirira kurufu zvinorwadza zvakakwirira.